Sciatica: Causes, Symptoms and How to Get Rid of It (Physio Guide)

The pain starts in your lower back, radiates into your buttock, and shoots down the back of your leg — sometimes all the way to your foot. It burns, it tingles, it aches. Some days it's electric; other days it's a relentless throb.

That's sciatica. And while it can be debilitating, the good news is that the vast majority of sciatica cases resolve with conservative care — without injections and without surgery.

Here's what's actually happening and what works.

What Is Sciatica — Actually?

The term "sciatica" describes symptoms, not a diagnosis. It refers to pain that follows the distribution of the sciatic nerve — the largest and longest nerve in the body, formed from the L4, L5, S1, S2 and S3 nerve roots as they exit the lumbar spine and sacrum.

True sciatica involves pain, numbness, tingling or weakness that radiates from the lower back or buttock down the leg. The specific distribution depends on which nerve root is involved:

• L4 root: Pain into the front/inner thigh and shin; weakness with knee extension; reduced knee jerk reflex
• L5 root: Pain into the outer leg and top of foot; weakness with foot/big toe extension (foot drop in severe cases)
• S1 root: Pain into the outer calf and little toe side of foot; weakness with calf raises; reduced ankle jerk reflex

What Causes Sciatica?

Lumbar Disc Herniation (Most Common)

A herniated disc at L4-5 or L5-S1 is the most common cause of true sciatica. The herniated nucleus pulposus either directly compresses the nerve root, or chemically irritates it through inflammatory mediators — producing the characteristic radiating pain even without direct contact.

Piriformis Syndrome

The piriformis muscle sits deep in the buttock and the sciatic nerve passes either beneath it or — in 15–20% of people — directly through it. When the piriformis becomes tight or inflamed, it can compress the sciatic nerve. Piriformis syndrome produces sciatica-like symptoms without any spinal pathology — an important distinction for treatment.

Spinal Stenosis

Narrowing of the spinal canal or intervertebral foramina from degenerative changes (bone spurs, thickened ligaments, disc height loss) can compress nerve roots. More common in adults over 50. Typically causes bilateral (both sides) leg symptoms that are worse with walking and relieved by sitting or bending forward.

Sacroiliac Joint Dysfunction

Can refer pain into the buttock and upper leg in a pattern that mimics sciatica — but without nerve compression. An important differentiation, as treatment is completely different.

How Is Sciatica Diagnosed?

Clinical diagnosis is usually straightforward. Your chiropractor or physiotherapist will assess:

• Straight leg raise test — lifting the leg with the knee straight stretches the sciatic nerve; reproduction of leg symptoms below the knee at less than 60 degrees is a positive test
• Slump test — a more sensitive neural tension test in sitting
• Myotomes — testing specific muscles to identify which nerve root is affected
• Dermatomes — mapping the distribution of numbness or altered sensation
• Reflexes — knee jerk (L4), ankle jerk (S1)

Imaging (MRI) is indicated if clinical findings suggest significant nerve compression, if symptoms fail to improve with conservative care, or if red flags are present.

Treatment That Actually Works

Chiropractic Adjustment and Mobilisation

Spinal manipulation restores movement to restricted lumbar segments and reduces the mechanical compression on affected nerve roots. Flexion-distraction technique is particularly effective for disc-related sciatica — gently decompressing the lumbar spine and reducing intradiscal pressure.

Soft Tissue Therapy to the Piriformis

For piriformis syndrome, targeted trigger point therapy and manual release of the piriformis dramatically reduces nerve compression. Combined with piriformis stretching and hip external rotator strengthening.

Neural Mobilisation (Neural Flossing)

Gentle oscillatory movements that mobilise the sciatic nerve within its surrounding tissue. Reduces neural sensitivity and adhesions that can perpetuate symptoms. Performed both in clinic and as a home exercise.

Core Stabilisation Exercise

Deep stabiliser activation (transversus abdominis, multifidus) reduces mechanical load on the lumbar spine and helps prevent recurrence. This is a core component of any sciatica rehabilitation program.

Red Flags — When to Get Urgent Help

Most sciatica is uncomfortable but not dangerous. Seek immediate emergency medical care if you experience:

• Loss of bladder or bowel control
• Numbness in the saddle area (inner thighs and groin)
• Progressive weakness in both legs
• Sciatica following significant trauma

These are potential signs of cauda equina syndrome — a rare but serious neurological emergency requiring immediate surgical decompression.

Nerve Flossing and Neural Mobilisation for Sciatica

Neural mobilisation — sometimes called nerve flossing or nerve gliding — involves moving the sciatic nerve through its full range of excursion by coordinating movement at multiple joints simultaneously. The technique aims to reduce neural tension, improve the nerve's ability to slide within its surrounding tissues and decrease the sensitivity of an irritated nerve root. Evidence for neural mobilisation as an adjunct to other conservative treatments for sciatica is increasingly positive, particularly for patients with significant neural tension signs on assessment.

Neural mobilisation exercises are distinct from standard stretching. They should be performed gently, within a pain-free or near-pain-free range, and should not reproduce or significantly increase leg symptoms. If they do, the technique needs to be modified. Your chiropractor or physiotherapist will assess your neural tension and prescribe specific mobilisation techniques appropriate for your presentation — what works for one sciatic presentation may be contraindicated for another.

Managing Sciatica Day to Day

Practical load management is as important as hands-on treatment for sciatic presentations. Prolonged sitting is typically the most provocative activity — the combination of lumbar flexion and hip flexion compresses the nerve root at the disc level and places the sciatic nerve under tension throughout its length. Breaking sitting with regular standing or walking (every 20–30 minutes) significantly reduces cumulative nerve irritation throughout the day.

Sleeping position also matters. Side-lying with a pillow between the knees maintains a neutral pelvic position and reduces rotation through the lumbar spine. Prone sleeping (face-down) increases lumbar extension and is generally poorly tolerated in acute sciatic presentations. Your chiropractor will provide specific positional advice based on your pain pattern and directional preference.

Frequently Asked Questions

How long does sciatica take to go away?

Most sciatica cases improve significantly within 4–8 weeks and resolve completely within 12 weeks with appropriate conservative care. Symptoms that persist beyond 12 weeks despite treatment warrant further investigation and possible specialist referral.

Should I rest if I have sciatica?

Complete bed rest is not recommended. Studies consistently show that staying as active as tolerable leads to faster recovery than bed rest. Avoid specific aggravating activities (prolonged sitting, forward bending, heavy lifting) but maintain gentle daily movement.

Can sciatica go away on its own?

Sciatica can improve spontaneously — particularly if caused by a disc herniation, which can naturally resorb over time. However, untreated sciatica often takes longer to resolve, has a higher recurrence rate and leaves underlying contributors unaddressed. Conservative treatment significantly accelerates recovery and reduces recurrence.

What's the best sleeping position for sciatica?

Side-lying with a pillow between your knees is typically the most comfortable for sciatica patients — it reduces lumbar rotation and takes tension off the affected nerve root. Stomach sleeping is generally the worst position, as it hyperextends the lumbar spine.

Our Bella Vista chiropractors assess and manage sciatica using a combination of spinal manipulation, neural mobilisation and progressive loading. For information on whether imaging is needed, see our article on do you actually need a scan for back pain. Understanding the difference between a disc bulge and herniation can also help contextualise what your symptoms mean.

References

1. Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation. JAMA, 296(20), 2441–2450.
2. Chiu CC, et al. (2015). The probability of spontaneous regression of lumbar herniated disc. Clinical Rehabilitation, 29(2), 184–195.
3. Rubinstein SM, et al. (2019). Spinal manipulative therapy for acute low back pain. Spine, 44(15), e882–e900.
4. Albert HB, et al. (2012). Does nuclear tissue infected with bacteria cause disc herniation? Spine, 38(13), 1115–1120.